<form action="{:sysuri()}" class='layui-form layui-card' data-auto="true" data-table-id="DataTable" method="post">

    <div class="layui-card-body padding-left-40">
        <div class="layui-form-item">
            <span class="help-label"><b>入金账号</b>Payment Channel</span>
            <label class="block full-width">
               
                <select name="code_1" class="layui-select" lay-filter="payment-type" lay-search>
                    <option selected value="">账号1，sdfadsfas</option>
                    <option value="">账号2,dsfdasfasfas</option>
                </select>
             
                <span class="help-block"><b>必选，</b>请仔细核对选择入金账号</span>
            </label>
        </div>
        <label class="layui-form-item block relative">
            <span class="help-label"><b>支付方式</b>Name</span>
            <select name="code_2" class="layui-select" lay-filter="payment-type" lay-search>
                <option selected value="">支付宝</option>
                <option value="">微信</option>
                <option value="">转账支付(单笔支付不超过1000美元)</option>
                <option value="">...</option>
            </select>
        </label>

        <label class="layui-form-item block relative">
            <span class="help-label"><b>入金金额</b>Code01</span>
            <input class="layui-input" name="code_3" placeholder="必填，请输入入金金额" required value='{$vo.code_1|default=""}'>
            <span class="color-desc">必填，请输入入金金额</span>
        </label>

    <div class="hr-line-dashed"></div>
    {notempty name='vo.id'}<input name='id' type='hidden' value='{$vo.id}'>{/notempty}

    <div class="layui-form-item text-center">
        <button class="layui-btn" type='submit'>提交申请</button>
        <button class="layui-btn layui-btn-danger" data-close data-confirm="确定要取消编辑吗？" type='button'>取消编辑</button>
    </div>
</form>
